Hysterectomy—the surgical removal of the uterus—is the second most common major operation among women in the United States today, second only to cesarean section. According to the National Women's Health Information Center, over 600,000 American women have a hysterectomy every year, and ⅓ of American women will have a hysterectomy by age 60. The National Women's Health Information Center. Hysterectomy. Frequently Asked Questions [online], U.S. Department of Health and Human Services Office on Women's Health, Jul. 1, 2006 [retrieved on May 4, 2010]. Retrieved from the Internet: <URL: http://www.4women.gov/faq/hysterectomy.htm>.
Hysterectomy may be performed for a variety of reasons, including removal of reproductive system cancers, prophylactic treatment for those with a strong family history of such cancers, treatment for severe and intractable endometriosis and severe fibroids.
Hysterectomy can be performed in several different ways. Abdominal incision, or laparotomy, is the oldest known and most commonly performed technique in the United States, followed by vaginal hysterectomy, where the surgery is performed through the vaginal canal. Laparoscopic hysterectomy, which has been in conventional practice for just over a decade, allows the uterus to be detached from inside the body by laparoscopic instruments, while the doctor views the uterus, fallopian tubes and ovaries through a camera attached to a telescope. For example, in total laparoscopic hysterectomy (“TLH”), surgically separated tissue (i.e., the uterus and cervix) is removed through an incision at the top of the vaginal canal. The vaginal cuff created during hysterectomy—the portion of the vaginal vault remaining open to the peritoneum—is then closed via laparoscopic suturing. Laparoscopic-assisted supracervical hysterectomy (“LASH”) employs in-situ morcellation to cut the uterus into small pieces that are removed via the laparoscopic ports, sparing the cervix.
Advantages of laparoscopic hysterectomy over abdominal or vaginal hysterectomy include smaller incisions, less patient discomfort, reduced complications, reduced hospital stay of, on average, one day, and a faster return to normal activity (2 weeks for laparoscopic hysterectomy, as compared to 6 weeks or longer for abdominal hysterectomy). Laparoscopic surgery also reduces blood loss, allowing a surgeon to detach blood vessels to the uterus while viewing them through the laparoscope. The uterus can then be removed more easily through the vagina, and with less blood loss.
Despite the clear advantages of laparoscopic hysterectomy, a significant number of hospitals and surgeons do not promote the surgery over alternative methods. Reasons include reluctance on the part of surgeons to learn laparoscopic techniques and longer operating times associated with laparoscopy.